HomeMy WebLinkAbout2201 W 18th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 10/08/96 LC Permit No: 539
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot:
Port Angeles,WA98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------------------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
/ /
/ /
$0.00
Work to Perform:
Watermain
Sanitary Sewer
Storm Drain
Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
PROJECT
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Corom Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer system Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc: BACK FLOW TEST
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$43.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
WATER
BAL DUE:
R/W
SANITARY
STORM
DWY
DRA
OTHER
$43.00
$43.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read an mined' plication and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will b co plied e specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
pro . . ns f any loc aw regulating construction or the performance of construction.
Date
Si nature of Owner if owner is builder
Date
~--.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT . . . . . . . . . . .
//
REQUEST'
Date
Time
Received by
(phone, person)
location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing
,;2;; 0/
w/~
5/()
~
\:j
"'-......
~.
~
~
\g
Phone No
Permit No
Final Sewer Excav Other
INSPECTION NOTES: ________ I
Inspected Date 5-J.1-9!f Time II '00/'14'1 By ~~
Remarks ~A'" Pr-ICb-\- .s -eA""~ l4.o\-- To ,-/" j:::'"./'c:...L.I"\-c.. - '-I~I ,:)VC-
/tc.'i5' E",-:./ @f}. wMr::, t/Jt:dv-e... /ot:'A-kd M FA,'fCh,l'(& t/~'5J't1- Q,..'vc.lA.I14/
BAc.~e-'lt \...V:~ ,^~...l I'\--J 10 ~ t.U.-~~ t.. 0 F '
c.o~~' Bl....ck lOp CLA-~ :3 I c).t C.u,...b /.4..-e.,< o.;~J
s 'd ~~p
':...
~
~'l ~
,~ ~
~~.
IV,. \.
~ ...,.. C'\
~...'-l
l.l
RESTORATION REQUIRED . . . . .. YES
.e j\"
CDJf1" 16.-1\'1
(J;~'
v
NO
/~p
~of I ( v..(,
\pI tll-
\\
.0(
I~~'
~
u)e'i>~ l8'+~
SURFACE RESTORATION !::>x!5 PtC- ~ UAJ &0-0 (
SURFACE TYPE 0 Unimproved 0 Gravel ~sPhalt 0 PCC D Other
D Repaired by City
D Repaired by Permittee
D No Damage Found
(DATE)
.s
~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 8/26/96 TF Permit No: 510
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles,WA98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------------------------------------------------
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: SYNERGY CONSTRUCTION INC
Start:
Finish:
/ /
/ /
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
Work to Perform: INSTALL * Watermain
* Sanitary Sewer
* storm Drain
Underground Tele/Ele
* Misc
PROJECT NOTES-------------------------------------------------------------------
onsite utilities need to be pressure tested all water lines need
Bacteria & pressure tests prior to connection to w/m / additional FH ?
$250.00 charge for hot tap for fire hyd if city does tap
balance of $3426.00 paid on 1/23/97 leh recipt #2661
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav: * $40.00 San Sewer SFR: $0.00
Sidewalk: $0.00 San Sewer MFR: * $80.00
Curb/Gutter: $0.00 Add Unit: 16
Driveway: $0.00 Other San Sewer: * $96.00
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: * $500.00 Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: * $40.00
5/8" Sewer System Dev: * $3,210.00
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Comm Water Serv: $1,500.00 D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
* 1 1/2" Misc: $0.00
2 " ==============================
Oth Water Serv: * $250.00
Water Sys Dev~ $4,415.00
Receipt No:
Inspection Fee:
-z- ~ (;'2----
$0.00
1/~71 q1
TOTAL FEE:
AMT PAID:
$10,131.00
$10,131.00
BAL DUE: /.::? $0.00 D
fVG ,/q 24> ~,/
R/W SANITARY WATER DWY STORM DRA OTHER ~.
Separate Permits are required for electrical work, utilities, private and public improvements. This permtt becomes null and void if work or f!:3'/ I
construction authorized is not commenced wtthin 180 days, if construction or work is suspended or abandoned for a period of 180 days after /f 7
the work as commenced, or if required inspections have not been requested wtthin 180 days from the last inspection. I hereby certify that I have / I
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether s~ecified herein or not. The granting of a permtt does not presume to give authority to violate or cancel the
provisiOnS~any ~of.locallaw,regUlating construction or the performance of construction.
-,1://..<, .~, 199/
Sf nature of C r;tr~ctor or A . orized A ent / le
Si nature of Owner if owner is builder
Date
~~
~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 10/08/96 LC Permit No: 539
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot:
Port Angeles,WA98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------------------------------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform:
Watermain
Sanitary Sewer
Storm Drain
Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
PROJECT
/ /
/ /
$0.00
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Corom Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc: BACK FLOW TEST
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$43.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
WATER
BAL DUE:
R!W
SANITARY
DWY
STORM
DRA
OTHER
$43.00
$43.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void ~ work or
construction authorized is not commenced within 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the worK as commenced, or ~ required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Sin nature of Owner (~ owner is buiider)
Date
Sionature of Contractor or Authorized Agent
Date
~
~~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 8/26/96 TF Permit No: 510
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot:
Port Angeles,WA98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------------------------------------------------
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: SYNERGY CONSTRUCTION INC
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL * Watermain
* Sanitary Sewer
/ /
/ /
$0.00
* Storm Drain
Underground Tele/Ele
* Misc
PROJECT NOTES-------------------------------------------------------------------
onsite utilities need to be pressure tested all water lines need
Bacteria & pressure tests prior to connection to w/m / additional FH ?
$250.00 charge for hot tap for fire hyd if city does tap
PROJECT FEES ASSESSMENT-----------------------------------------------------____
R/W Excav: *
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut: *
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Corom Water Serv:
1"
* 1 1/2"
2"
Oth Water Serv: *
Water Sys Dev:
Receipt No:
Inspection Fee:
R/W
SANITARY
OTHER
$40.00
$0.00
$0.00
$0.00
$0.00
$500.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR: *
Add unit: 16
Other San Sewer: *
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea: *
Sewer System Dev: *
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$80.00
$96.00
$0.00
$0.00
$0.00
$0.00
$40.00
$3,210.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$1,500.00
$250.00
$4,415.00
TOTAL FEE:
AMT PAID:
$0.00
BAL DUE:
$10,131.00
$6,705.00
$3,426.00
Separate Permits are required for electrical work, utilities, private and public improvements. This perm~ becomes null and void ~ work or
construction authorized is not commenced ~hin 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or ~ required inspections have not been requested ~hin 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a perm~ does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
WATER
DWY
STORM
DRA
Date
Sianature of Owner lIT owner is builder)
Date
Sianature of Contractor or Authorized Aaent
PUBLIC \JORKS CONSTRUCTION Issued: Y ~ 1/ f; Permit No: 510
&. R/Y PERMIT cond: !,larK Order: 0
OWNER/APPLICANT----~------------,-------PROPERTY lOCATION------------------------
/
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "CIl ST Lot:
Port Angeles,wA98362 BLock: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------------------------------------------------
Work is INSIDE traveLed road VaLue Work: SO.OO
Plans Required: N/A
Contractor: SYNERGY CONSTRUCTION INC
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
/ /
/ /
$0.00
work to Perform: INSTALL * Watermain * Storm Drain
* Sanitary Sewer Underground TeLe/Ele
* Mise
PROJECT NOTES-------------------------------------------------------------------
onsite utilities need to be pressure tested all water lines need
Bacteria & pressure tests prior to connection to w/m / additional FH ?
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W E,xcav: * ~ San Sewer SFR: SO.OO
SidewaLk: SO_OO . San Sewer MFR: * $80.00
Curb/Gutter: SO.OO Add Unit: 16
Driveway: SO.OO Other San Sewer: *
Dwy Culvert: $0 o~ Sew Tap wye/Man Tap:
Street Cut: * ('$500.00 Sew Cap/ W/M Removal:
Other R/W: SO.OO Alter/Repair Sewer:
Fire tlydrant: SO.OO Storm Drain Tap:
Res Water Serv: SO.OO Catch Basin per ea: *
5/8" Sewer System Dev: *
3/4" Mi lwaukee Dr. Sew Assess:-
111 R/I,J Use Perm:
Comm Water Serv: $1,500.00 D.R.A.:
1"
* 1 1/2"
2"
Admin Costs (D.R.A):
Mise:
$96.00
$0.00
$0.00
$0.00
$0.00
$40.00
$3,210.00
$0.00
$0.00
$0.00
$0.00
$0.00
----------~~-~----------------
------------------------------
Oth Water Serv:
Water Sys Dev:
$0.00
$4,415.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
'22/1.3
$0.00
BAL DUE:
$9,881.00
$540.00
$9,341. 00